Provider Demographics
NPI:1184443061
Name:MOORE, ANGELA CHILTON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHILTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:GAIL
Other - Last Name:CHILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1025 TREVOR DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9697
Mailing Address - Country:US
Mailing Address - Phone:336-970-9697
Mailing Address - Fax:
Practice Address - Street 1:4008 MENDENHALL OAKS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8302
Practice Address - Country:US
Practice Address - Phone:336-697-6150
Practice Address - Fax:336-860-6320
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist